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Sandy FEMA Review Process: What is the role of the Neutral Reviewer?

Sandy FEMA Review Process:  What is the role of the Neutral Reviewer?

According to FEMA, the role of the Neutral Reviewer in the Sandy FEMA Review Process is to issue a recommendation to FEMA based upon the information in the case file and any clarifications provided by policyholders, their representatives and FEMA personnel.  The adjuster will make a recommendation after a review of the claim file and any new documentation or information provided by the policyholder during the desk review.  If the policyholder does not agree with the recommendation, the policyholder will have the opportunity to request in writing an additional review of the claim file by a Neutral Reviewer, who may be a retired judge or attorney.  After the policyholder’s request, the Neutral Reviewer will assess the claim file and will contact the policyholder to discuss any concerns.  The Neutral Reviewer will consider the information contained in the case file, which should be the same information provided to policyholders and their attorneys (if applicable).  The Neutral Reviewer will then issue a recommendation.

However, according to FEMA, the Neutral Reviewer – as a contractor of the government – does not have the ability to direct payments or bind FEMA to any particular result that requires expenditure of government funds.  FEMA may then adopt the recommendation by the third-party neutral reviewer and may authorize the recommendation for payment to the policyholder when the finding is in compliance with NFIP regulations and policy.  Once the final determination on a recommendation is received from a third-party neutral, FEMA must adhere to NFIP regulations and policies that are currently in effect, including those that limit or disallow coverage of certain expenses as outlined in the Standard Flood Insurance Policy.  The Neutral Reviewer will issue a recommendation based upon the information in the case file and any clarifications provided by policyholders, their attorneys and FEMA personnel during oral presentations (if requested).

About the Author: Christopher W. Gerold is an attorney in Chiesa, Shahinian & Giantomasi’s (“CSG”) Disaster Recovery Claims Group. For the past three years, Chris has been representing homeowners, condominium associations and businesses with their Sandy related insurance claims with a special focus on flood insurance. For more information on flood insurance and ways CSG can help you with your flood insurance claim, please contact Chris at (973) 530-2061.